Tasman Medical Journal

ISSN:  2652-1881

Volume 2020 - Issue 3.

Healthcare worker safety of high-flow nasal oxygen and non-invasive ventilation use in COVID-19 patients: a systematic review and meta-analysis

Hamish Newman, Toby Price and Edward Litton


Background High-flow nasal oxygen (HFNO) and non-invasive ventilation (NIV) may reduce the requirement for invasive ventilation in selected patients with respiratory failure. For patients with coronavirus disease 2019 (COVID-19), these modalities may generate aerosols and increase risk of viral transmission to healthcare workers (HCW). Uncertainty about relative risk of aerosol generating procedures (AGP) has contributed to strikingly different recommendation amongst international guidelines.

Methods We reviewed available literature pertaining to safety of NIV and HFNO for HCW caring for patients with acute coronavirus infections, including COVID-19. Ovid MEDLINE and Embase were searched for the period 1 January 2003 to 22 May 2020, identifying 1095 articles with search terms relating to ‘NIV’ or ‘HFNO’ and ‘coronavirus’. Twenty-four studies satisfied the inclusion criteria.

Results The quality of evidence was generally poor. Ten studies assessed risk of transmission to HCW, and of these seven were included for quantitative analysis of 1112 HCW caring for 78 patients. For NIV exposure compared to no exposure, there was an increased risk to HCW (relative risk [RR] 2.02, 95% CI 1.30 to 3.11, I2=74.1%, p<0.01). For HFNO the RR was 0.61 (95% CI 0.19 to 1.99, I2=53.2%, p=0.8). Fourteen articles assessed relative dispersion distance of droplets with different face masks. Maximum dispersion distance was 91.2 cm with a loosely fitted BiPAP full-face mask operating at 20 cm H2O, and 17 cm with HFNO at 60 L/min.

Conclusion Available evidence is generally of poor quality but suggests that NIV, but not HFNO, may increase the risk of coronavirus transmission to HCW.


The Australian Inherited Retinal Disease Registry and DNA Bank

John N De Roach, Terri L McLaren, Jennifer A Thompson, Ling Hoffmann, Isabella R Urwin, Samuel McLenachan, David A Mackey, Fred K Chen and Tina M Lamey


Background: Inherited retinal disease (IRD) is the most common cause of blindness in adult Australians. With the emergence of personalised gene-specific and variant-specific treatment trials and the 2017 release of the first accredited IRD gene-specific therapy, it is increasingly important to establish repositories of genetic data from IRD patients, including genetic analyses outcomes. This paper describes an Australian data repository and its contributions to research and patient management to date.

Design: Participants were recruited from Retina Australia membership, the Sir Charles Gairdner Hospital visual electrophysiology clinic, by referral by ophthalmologists, or by unsolicited approaches to potential participants. Nine thousand two hundred and ninety-eight participants were recruited, of whom 4097 (44%) were classified as affected and 1451 (16%) as a carrier. Participants were from families in which at least one member had a known IRD.

Methods: DNA was collected from WA participants from 2001, and the activity was extended Australia-wide in 2009. Family and clinical information was collected by interview, and by examination of medical records.

Main Outcome Measures: The main outcome measures were the number of DNA samples collected, number of genetic analyses carried out, number of families for which a causative gene was established and number of research diagnostic genetic reports provided to ophthalmologists and clinical geneticists.

Results: DNA has been obtained from 7275 participants from 2239 families, and 3827 genetic analyses have been carried out on DNA from 2646 participants from 1001 families. Eight hundred and twenty-eight participants sourced from 491 families had a causative gene identified. Research diagnostic genetic reports were provided to 1037 ophthalmologists or clinical geneticists.

Conclusion: This resource is a valuable tool for identifying cohorts of participants affected with an IRD suitable for personalised clinical trials or treatments, for research purposes and for facilitating informed genetic counselling.


FIM-score predictors of discharge destination in older patients admitted for inpatient rehabilitation

Wolfram Weinrebe, Katja Jeckelman Vonlanthen and Stefan Goetz


Objectives: To determine which dimensions of functional independence measure (FIM) scores or patient characteristics were associated with the possibilities of returning home or being admitted to a nursing home.

Design: Retrospective study of admissions and discharges by FIM score.

Setting: Clinic for acute geriatrics and rehabilitation at public hospital.

Participants: 1727 patients of rehabilitation and acute geriatric treatment over a period of 6.5 years.

Measurement: Functional independence measurement (total FIM and FIM sub-scores), age, marital status.

Results: 1118 women (64.8%) and 608 men (35.2%) took part in the study. 80% were discharged home. Patients discharged home were younger than those discharged to an institution (77.8 ± 9.9 (SD) / 83.4 ± 7.9 (p<0.01). Total FIM score on admission was 89.9 ± 21.0 versus 68.8 ± 23.1, respectively. (p<0.01). Significant contributing FIM score dimensions were 62.9 ± 16.9 versus 47.5 ± 17.8 for motor function (p<0.01) and 27.1 ± 6.67 versus 21.3 ± 7.4 for cognitive function (p<0.01). Marital status on admission had significant influence on total (p=0.00), motor (p=0.00) and cognitive FIM (p=0.02) scores. In patients living alone those who were divorced showed the highest FIM scores for motor and cognitive FIM.

Conclusion: Generally, total FIM scores on admission discriminated best between being discharged to a nursing home or to the community. Other factors were motor FIM score, the motor FIM subscore for intimate hygiene, and the cognitive FIM score. Tasman Medical Journal 2020; 2: 68-73.


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